Adaptation and Biomechanical Performance of Custom‐Fit Mouthguards Produced Using Conventional and Digital Workflows: A Comparative In Vitro Strain Analysis

Abstract

ABSTRACTBackground/ObjectivesThe use of different models for the fabrication of custom‐fit mouthguards (MTGs) can affect their final thickness, adaptation, and shock‐absorption properties. This study aimed to evaluate the adaptation, thickness, and shock absorption of ethylene‐vinyl acetate (EVA) thermoplastic MTGs produced using conventional plaster or three‐dimensional (3D) printed models.Materials and MethodsA typical model with simulated soft gum tissue was used as the reference model to produce MTGs with the following two different protocols: plast‐MTG using a conventional impression and plaster model (n = 10) and 3DPr‐MTG using a digital scanning and 3D printed model (n = 10). A custom‐fit MTG was fabricated using EVA sheets (Bioart) plasticized over different models. The MTG thickness (mm), internal adaptation (mm) to the typodontic model, and voids in the area (mm2) between the two EVA layers were measured using cone‐beam computed tomography images and Mimics software (Materialize). The shock absorption of the MTG was measured using a strain‐gauge test with a pendulum impact at 30° with a steel ball over the typodont model with and without MTGs. Data were analyzed using one‐way analysis of variance with repeated measurements, followed by Tukey's post hoc tests.ResultsThe 3DPr‐MTG showed better adaptation than that of the Plast‐MTG at the incisal/occlusal and lingual tooth surfaces (p < 0.001). The 3DPr‐MTG showed a thickness similar to that of the Plast‐MTG, irrespective of the measured location. MTGs produced using both model types significantly reduced the strain values during horizontal impact (3DPr‐MTG 86.2% and Plast‐MTG 87.0%) compared with the control group without MTG (p < 0.001).ConclusionThe MTGs showed the required standards regarding thickness, adaptation, and biomechanical performance, suggesting that the number and volume of voids had no significant impact on their functionality. Three‐dimensional printed models are a viable alternative for MTG production, providing better adaptation than the Plast‐MTG at the incisal/occlusal and lingual tooth surfaces and similar performance as the MTG produced with the conventional protocol.